Individual
DESMOND PEYTON KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
200 PATEWOOD DR, SUITE A200, GREENVILLE, SC 29615-3593
(864) 454-5115
Mailing address
1 INDEPENDENCE PT STE 212, GREENVILLE, SC 29615-4536
(864) 797-6303
(864) 797-6198
Taxonomy
Speciality
Code
Description
License number
State
2080P0006X
Developmental - Behavioral Pediatrics Physician
Primary
17873
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1276609
CIGNA
SC
05
—
178738
—
SC
01
—
576007863037
BLUE CHOICE OF SC
SC
01
—
576007863094
BCBS OF SC
SC
Enumeration date
05/16/2006
Last updated
02/28/2018
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